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Published on: March 26, 2019
Predicting outcome from coma: man-in-the-barrel syndrome as potential pitfall
J W Elting1, R Haaxma, G Sulter
1Department of Neurology, University Hospital Groningen, PO Box 30. 001, 9700 RB, Groningen, The Netherlands.
Clinical Neurology and Neurosurgery
|March 16, 2000
Summary
The Glasgow Coma Scale motor score may be unreliable for predicting outcomes in patients with hypotension-induced coma. Borderzone infarction can mimic poor neurological status, highlighting the need for advanced imaging.
Area of Science:
- Neurology
- Neurosurgery
- Neuroradiology
Background:
- The Glasgow Coma Scale (GCS) motor score is a critical prognostic indicator in hypoxic-ischemic coma.
- Controlled hypotension during surgery can lead to neurological complications.
- Borderzone infarction can present diagnostic challenges in coma patients.
Observation:
- A patient undergoing skull base surgery for a facial nerve schwannoma remained comatose post-operation with absent motor response.
- Controlled hypotension was employed during the 10-hour surgical procedure.
- Brain imaging revealed bilateral lesions in the arm-hand area, consistent with borderzone ischemic damage.
Findings:
- Absent GCS motor score in the context of hypotension-induced coma may not always indicate a poor prognosis.
- Magnetic Resonance Imaging (MRI) with specific sequences (inversion recovery) identified subtle ischemic changes.
- These findings suggest that borderzone infarction can confound traditional neurological assessments.
Implications:
- Clinical assessment of coma patients, particularly after hypotension, should be supplemented with advanced neuroimaging.
- Relying solely on GCS motor score may lead to misinterpretation of neurological prognosis.
- Optimal supportive care combined with accurate diagnosis of ischemic injury can lead to favorable outcomes.
